Provider Demographics
NPI:1407955198
Name:DERMATOLOGY AND SURGERY, PC
Entity Type:Organization
Organization Name:DERMATOLOGY AND SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:K
Authorized Official - Last Name:BEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-210-4855
Mailing Address - Street 1:5910 ASHWORTH RD # 222
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-7108
Mailing Address - Country:US
Mailing Address - Phone:515-241-2000
Mailing Address - Fax:515-241-2013
Practice Address - Street 1:610 10TH ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:IA
Practice Address - Zip Code:50220-2221
Practice Address - Country:US
Practice Address - Phone:515-465-8111
Practice Address - Fax:515-241-2013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA28377207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA=========OtherCORP TAX ID #
IA=========OtherCORP TAX ID #